Headache Flashcards
(51 cards)
important points to explore in a history?
SOCRATES
triggers
auras, visual disturbances
red flags
red flags for headache?
new onset HA >55 new/ previous Hx of malignancy immunosuppressed early morning HA which wakes you up exacerbated by valsalva manouvre persistent severe headache, worse at night associated weight loss
what ees dees?
a common cause of headache which occurs intermittently characterised by recurrent
episodes of headache lasting a few hours to a few days.
migraine
attacks of migraine can usually be associated with known triggers e.g.
stress skipping meals binge eating menstruation or ovulation oral contraceptive bright sunshine
clinical features of migraine?
at least 5 attacks in 5-72hrs:
- unilateral throbbing headache
- worse on movement
- photo/phonophobia (require dark room)
- N&V
how may migraine present differently in children?
shorter, may be bilateral, more prominent GI symptoms
T/F: most migraines occur with aura
false - 20%
what is an aura? (with migraine)
reversible visual, auditory, motor or language symptoms inc zigzag lines, central or hemianopic scotoma, aphasia and muscle weakness occurring before or at the start of the headache
which medication is completed contraindicated in pts with migraine with aura and why?
COCP- significantly increased risk of ischaemic stroke
diagnosis of migraine?
no other physical symptoms: clinical
weakness, aphasia, other Sx: CT scan (rule out stroke)
treatment of migraine?
trigger avoidance
mild: high dose NSAID +/- antiemetic
severe: oral triptan (rizatriptan, sumatriptan) +/- NSAID +/- antiemetic (even w/o N&V)
SEs of triptans?
dizzy, drowsy, altered temperature sensation, tingling sensations, chest/ throat tightness or heaviness
contraindications of triptans?
coronary vasospasm
ischaemic heart disease
previous cerebrovascular accident
what can be used as migraine prophylaxis? indications for this?
> 3 attacks/ month or severe
- propranolol or topiramate
how is a tension type headache often described?
tight band around head often radiating to neck
triggers of tension type headache?
stress, depression, anxiety
believed to be caused by stiffening of muscles of face and neck
clinical features of tension type headache?
band like pressure around head radiating to neck
tingling sensation in head
absence of what clinical features is important for a diagnosis of tension headache?
N&V or photo/phonophobia
treatment of tension type headache?
reassurance
relaxation
amitriptyline in chronic refractory tension type HA
what are Trigeminal autonomic cephalgias?
a group of HA disorders categorised by unilateral pain (often severe) in distribution of trigeminal nerve. Often associated with autonomic symptoms on ipsilateral side
3 types of TAC?
cluster HA
trigeminal neuralgia
paroxysmal hemicrania
where did cluster headache get its name?
tends to occur in clusters during the day (1-8 times) and for a certain period of the year (weeks-months) before ceasing for a long period of time
demographic for cluster HA?
men 20-55
clinical features of cluster HA?
1) symptoms
2) timing
3) how often/ day
severe unilateral stabbing retro-orbital, supra-orbital or temporal region pain
ipsilateral autonomic features: ptosis, miosis lacrimation, nasal stuffiness, chemosis
cicardian rhythm of onset (often night or early morning)
last 10 minutes - 3 hours, 1-8 times/ day
